Lower Extremity Purpura
Huan J. Chang, MD, MPH
A 50-year-old woman comes to your office for evaluation of a vasculitic-appearing cutaneous eruption of unknown duration on
the lower extremities. Her medical history includes heavy smoking with subsequent chronic obstructive pulmonary disease (COPD).
Findings from a general physical examination show her to be a cachectic woman who appears older than her stated age. Cutaneous
examination reveals a perifollicular, hyperkeratotic purpuric eruption on her lower extremities. Pertinent laboratory values
showed megaloblastic anemia, low serum folate levels, and a mild elevation of liver function test results.
See the full article for an explanation and discussion.
Author Affiliation: Dr Chang (tina.chang{at}jama-archives.org) is Contributing Editor, JAMA.